Provider Demographics
NPI:1477209997
Name:THORNTON, KAREN V
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:V
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOUNTAIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8992
Mailing Address - Country:US
Mailing Address - Phone:304-616-3687
Mailing Address - Fax:304-816-3737
Practice Address - Street 1:16 MOUNTAIN PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8992
Practice Address - Country:US
Practice Address - Phone:304-616-3687
Practice Address - Fax:304-816-3737
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVT6534618390913747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider